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Investigation: GPs cope with fallout from private screening explosion

A Pulse investigation reveals the growing disquiet among GPs over the pressure placed on the NHS by private tests and scans

Type in private health screening on Google and you will find nearly 300,000 articles - in the UK alone.

There are not quite that many private firms lining up to make a profit from patients, but it gives an idea of the scale of this rapidly growing industry - now estimated to be worth £49 billion globally.

A dizzying array of checks – MRI and CT, DEXA scans, vascular checks, allergy tests and cancer screens to name just a few – have emerged to capitalise on modern Britain's growing obsession with preventive health. These days people are more worried about getting themselves an MOT than their car.

This week a Pulse investigation reveals the impact private testing is having on GPs, who are finding themselves increasingly faced with patients clutching results they have paid for privately – but who expect treatment on the NHS.

We surveyed more than 260 GPs, who told us they are often having to deal with the fallout from the explosion in private screening.

Four GPs in five reported seeing patients who have requested treatment for suspected problems uncovered by private screening.

But fewer than half the GPs in our survey – 46% - felt the NHS should pick up the tab. More than a third said they did not believe the NHS should be liable for the care of suspected problems uncovered by private tests, while 19% were unsure who should foot the bill.

Pulse has learned the UK National Screening Committee is now assessing the evidence for a variety of health tests, and urgently drafting guidance for GPs. But in the meantime, an ethical debate is raging in primary care.

The GPC has several reservations about the booming private health test industry. GPC member Dr Andrew Green, a GP in Hedon, east Yorkshire, says while the BMA is pleased patients are taking an interest in their health, it is unconvinced companies are offering a valid service.

‘Most patients don't understand things like false positives and negatives, and there's often little effort made to explain what the tests mean before patients pay their money.

‘The first rule of medicine is first do no harm, and I'm uncomfortable with the notion these tests do no harm. They do, and I don't just mean the psychological harm and anxiety caused by being told there's something wrong with you.'

Mr Jonothan Earnshaw is secretary of the Vascular Society and director of the NHS aortic abdominal aneurysm screening pilot programme.

As a vascular surgeon he is well aware of the kinds of controversial treatment that can result from checks for cardiovascular abnormalities.

‘Generally finding people with a vascular disease early is a good thing. But in certain areas, like asymptomatic carotid endarterectomy for carotid stenosis, there is a very small advantage from having surgery. You would have to do about 40 procedures to prevent one stroke.

‘We don't tend to do this operation in the UK but an ultrasound result saying you have an aortic aneurysm causes huge anxiety.'

He insists Bupa goes to great lengths to make sure patients are aware of the risks, as well as benefits, of testing.

‘There are very different types of screening. The ones Bupa offers are useful and discover something that can be treated – like cholesterol and blood pressure, or where people are just curious about their health, like haemoglobin tests.

‘There's a lot of clinical evidence behind cholesterol and blood pressure tests and arguably a benefit in people knowing if they are anaemic. We do offer counselling and all our results are contextualised so patients don't go away feeling concerned – 97% of our patients feel reassured by our tests.

‘Given a third of our customers come to us with conditions they don't feel they can go to their GP with, we can put a lot of minds at rest and do a lot of work the NHS would end up doing otherwise.'

Dr Malcolm Kendrick, a GP in Macclesfield and private scan cynic, strongly disputes that last point. He says private health testing companies create more work for GPs, not less. Companies, he says, are making money from vulnerable patients – and leaving GPs to clear up the mess.

‘It creates an incredible burden for GPs. To tell a patient "we've found an abnormality but we're not going to do anything about it" is unethical. They are preying on the innocent, creaming off the profits but taking none of the responsibility - just throwing it back to the NHS.'

Where the responsibility lies for treating conditions thrown up by private scans and tests is the source of growing controversy.

‘There's no question of the NHS picking and choosing who to treat,' says Dr Green. ‘But that does not mean the NHS should treat everything these tests might throw up. GPs need to be able to sit down and discuss the results with patients.'

On the other side of the debate and the Atlantic is Dr Andrew Manganaro, chief medical officer at Life Line Screening, a US-based company whose UK arm provides vascular ultrasound scans.

He accepts companies such as his may not always have ensured patients properly understood their test results, and pledges his company ‘will work harder to make the results of our tests clear'. But he rejects suggestions his company should be responsible for the follow-up care of patients who pay around £140 a scan.

‘My understanding of the UK healthcare system is that it treats for any condition irrespective of where it is diagnosed. The fact we found a disease does not relieve the NHS of its responsibility to the patient.

‘A screening company cannot be responsible for a patient's treatment. It's the same as if a GP diagnoses a condition. They are not necessarily responsible for that patient, they may refer them to someone else. So should GPs be stopped from referring to consultants?'

Life Line Screening may have a slick PR operation, but another company with a similar name – Life Scan – has had a bumpier ride over the last year.

Dr Margaret McCartney, a GP in Glasgow, complained to the Advertising Standards Authority about a ‘misleading and irresponsible' advert for CT scanning placed by Life Scan, which she felt could be falsely reassuring to patients.

The ASA upheld her complaint, ruling ‘the ad could discourage patients from seeking advice from their GP in situations where it would generally be considered more appropriate to do so'.

Dr John Giles, clinical director of Life Scan and a practising consultant radiologist, insists: 'I think the adjudication was wrong. [Dr McCartney did not like people circumventing their GP and coming to us instead, which seems a tad paternalistic. As a GP, I don't think she is up to speed with radiology and what we do. We offer a number of tests that are widely used in other countries but not in the UK.'

But Dr McCartney says: ‘The emphasis has to be on evidence. And if there's the evidence for a given screening process, it should be done on the NHS, not by the private sector. The question is what's evidence-based and what's not?'

Screening firms are not required to provide evidencce for their tests, but some do. Life LIne Screening's US division has compiled a database of five million patients, and reports 7%, or 350,00 abnormal tests. The validitiy of the results is being analysed by the US Society for Vascular Surgeons.

Pulse has learned the body with the job of making that call, the National Screening Committee, is drawing up guidance for GPs and the public on which types of scans are backed by evidence, and which are not.

Dr Surendra Kumar, a committee member and a GP in Widnes, says private health tests ‘go against the spirit of the NHS'.

‘Some of their claims are borderline unethical. We don't believe it is in the public's interest to have these tests. If there is evidence for a screening procedure it will be recommended to ministers. But health checks are not screening, which makes them difficult to regulate.'

But Dr Manganaro feels the growth in private screening ‘could be good for the NHS' – and says it is high time UK healthcare changed. ‘GPs should see this as an opportunity to encourage patients to be more proactive about their health,' he insists.

The glossy pamphlets may convince patients that private health tests are good for their health, but it may prove a much more difficult idea to sell to GPs.